Medicare Explained

Medicare Basics Explained

The information provided here is to explain Medicare coverage briefly. You can call us and a certified insurance agent will help with questions and information on what Medicare plans and options are available in Connecticut. Call us Today! 860-647-7353

What is Medicare?

Medicare is a federal health insurance program in the United States. The Centers for Medicare & Medicaid Services (CMS) is the government agency that regulates the Medicare health programs. CMS develops rules and regulations that must be followed by all Medicare plans, all Medicare medical providers, and all Medicare beneficiaries. As you can imagine, Medicare is an important part of health care for millions of Americans. Medicare helps you get health coverage, but you will still have to pay some of those medical costs.

Medicare only offers individual health plans. This means your spouse, or children will not be covered by your specific Medicare plan. However if they are eligible for Medicare, they can also enroll in a separate Medicare plan. This is good because each person can choose a Medicare health plan that best fits your medical needs and desires.

There are specific insurance brokers like myself who are familiar with the current Medicare rules and regulations. We are trained, tested and certified every year to help people with Medicare Health Plans properly. We can help you understand the Medicare enrollment process for Medicare Part A and Part B. Medicare Part A (hospital coverage) and Part B (medical Services) are issued by Social Security. You can call Social Security at this phone number 1-800-772-1213. Once you apply for your Medicare card with Social Security, we can help you with understanding your options with the many Medicare health plans availaable in Connecticut. There are no fees, charges, or increased costs for our help. The insurance companies will pays us directly to explain their Medicare health plan coverages and benefits to you. Once you understand and have chosen a medicare health plan we will enroll you into that Medicare health plan.

Who is eligible for Medicare?

Medicare can provide health care coverage for these persons:

  • People who are age 65 and older
  • People under 65 with disabilities
  • People with End-Stage Renal Disease, (this is a permanent kidney failure that requires dialysis, or a kidney transplant.)

    “Medicare Beneficiary” is the proper term which refers to people who are on Medicare.

The Federal government issues the Medicare Part A and Part B claim card. Generally speaking, if you are just turning age 65, Medicare allows you 7 months to enroll in Medicare Part A and Part B. These 7 months start 3 months before your age 65 birth month, your birth month, and 3 months after your birth month. However, there are exceptions to this rule.

There are special enrollment periods where a person can enroll into Medicare. Many people are retiring after age 65 and are enrolling at ages other than 65. There are many rules and regulations to watch out for. If you fail to follow these rules, you can be assessed penalties or could be left without a health plan. We enjoy helping people. Call 860-647-7353 and we will help you too.

What does Medicare cover?

Medicare is very different from the health plans you had at work. With work plans, you had a single plan for hospitals , doctors, prescriptions and other medical services. And your employer chose the plan or plans you could choose from.
With Medicare, you must understand the plan coverages, and choose your own plan. This is where we can help you understand the coverages and how you would benefit from the Medicare plans.

Medicare is made up of 4 different parts and each part covers different medical expenses.

Part A: Hospital coverage
Part B: Medical Services coverage
Part C: Medicare Advantage Plans
Part D: Medicare Prescription Drug Plans

Part A Hospital Insurance

Part A of Medicare typically helps pay inpatient hospital care, skilled nursing care , home health care, and hospice care. There is a pretty high deductible per admission and per benefit period that you must pay. There are also cost gaps in hospital coverage after 60 days and 90 days and after 150 days.
Most people do not have to pay for Medicare Part A coverage.

Part B Medical Services

Medical services helps pay for medical provider services and many other medical services and supplies that are performed without a hospital overnight stay. Most people pay a monthly charge for Medicare Part B. There is a yearly deductible and then a 20% cost share you must pay. The monthly cost is based on your income. Most people pay a monthly charge for Medicare Part B coverage.

Medicare Part A and Part B together are called “Original Medicare”. Medicare Part A and Part B will only help pay your medical bills. So you could be left with a large hospital bill and medical charges from deductibles and coinsurance costs. You should be able to purchase other Medicare plan options to fit your specific needs from private health insurance companies. We can help you with that information and help you understand the coverages and benefits of each plan..

Medicare Supplement Plans (Medigap Plans)

Private health insurance companies offer optional Medicare health plans that help supplement and fill the gaps in Medicare Part A and Medicare Part B. Medicare supplement plans help fill the deductibles and coinsurance that Medicare does not cover fully. Claims are usually submitted electronically to Medicare and Medicare sends the remaining costs to the Medicare supplement plan to pay their portion of the bill. If Medicare does not cover a medical procedure, then the Medicare supplement plan will not cover the procedure either.

Part D: Prescription Drug Plans

Prescription drug coverage helps pay for out-patient medications doctors prescribe for treatment. These drug plans are offered by private health companies. Medicare beneficiaries may also get additional help with drug coverage from government programs.

Enrolling in a Prescription Drug plan is not required, but if you do not have a credible prescription plan, there could be a 1% penalty per month, should you ever enroll in a Medicare Prescription Plan later. This penalty applies to you for the rest of your life.

The Center for Medicare and Medicaid Services oversees and regulates the levels of drug coverage, the deductibles, the copay’s and the coinsurance’s that the private drug companies must follow. The drug plan can be better, but not worst than the coverage regulated by CMS.

You may add or change or drop Prescription Drug coverage ONLY at specific times during the year or for specific reasons during the year. You must be entitled to Part A or enrolled in Part B in order to purchase a Medicare Prescription Drug Plan.

You can only have 1 drug plan.

Part C: Medicare Advantage Plans

Medicare advantage plans are health plans that are an option for Medicare beneficiaries like you. These plans are available in many areas in Connecticut. You must have Medicare Part A and be enrolled in Part B. You must also continue to pay the Medicare Part B premiums with a Medicare Advantage Plan.

People with Medicare Part A and Part B, can choose to receive all of their health care services through a Medicare advantage plan. These plans are offered though private insurance companies and must provide coverage equal to or better than Original Medicare. These plans may provide extra benefits not covered by Medicare. Medicare advantage plans may include prescription drug coverage. There may be an additional monthly premium paid to the Medicare health plan.

These advantage plans can offer extra coverages like dental, vision, hearing aids and more.

Medicare advantage plans have additional or different cost sharing than original Medicare.

Every Medicare advantage plan will have different doctors, hospitals, and prescriptions included in their plans.
Because Medicare advantage plans have networks of medical providers and You may have to change your doctors or hospitals.

You can only enroll, disenroll, or change Medicare advantage plans at specific times during the year and for limited specific reasons.

If you have a Medicare advantage plan, you do not need a Medigap plan or a Medicare supplement plan.

For more information, help or enrollment assistance . . . Call us today 860-647-7353.